| NPI | 1912585571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 93621) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 322723) |
| 207P00000X Emergency Medicine (Licence: IA DO-06771) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-06-30 |