| NPI | 1043248875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME176164) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101288386) |
| 207R00000X Internal Medicine (Licence: PA MD492198c) | |
| 207P00000X Emergency Medicine (Licence: OH 35075265S) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2026-07-20 |