| NPI | 1962942185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 1410517-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013944) |
| 207P00000X Emergency Medicine (Licence: HI DOS-2346) | |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2025-11-19 |