| NPI | 1902069131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-48465) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R70580) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2025-04-10 |