| NPI | 1902541014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 334392) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC MMD.87636) |
| 207P00000X Emergency Medicine (Licence: KY 60451) | |
| Enumeration Date | 2022-04-30 |
| Last Update Date | 2026-07-10 |