| NPI | 1902539315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 33418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 82984) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2026-08-11 |