| NPI | 1952756694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2017-02606) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101270999) |
| 207P00000X Emergency Medicine (Licence: PA MD478931) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2025-01-16 |