| NPI | 1932720786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 74586) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 33811) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2025-08-08 |