| NPI | 1962080291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-146597) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK 217900) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-04-15 |