| NPI | 1871150631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 82499) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL82499) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: SC MD82499) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-07-26 |