| NPI | 1972919660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK 130562) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 50067) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2025-11-13 |