| NPI | 1043201262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD176863) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 56485) |
| 207P00000X Emergency Medicine (Licence: NY 242879) | |
| 207P00000X Emergency Medicine (Licence: CA A82073) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2025-07-09 |