| NPI | 1972288660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 82168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-12960) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2026-08-06 |