| NPI | 1912430547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101272212) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0103074) |
| 207P00000X Emergency Medicine (Licence: CA A193061) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2026-06-30 |