| NPI | 1871098004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME160573) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 88378) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2026-04-28 |