| NPI | 1962627745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI MD14835) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R3172) |
| 207P00000X Emergency Medicine (Licence: WA MD60290516) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2025-08-25 |