| NPI | 1891794392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2007-00406) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 23212) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2025-08-12 |