| NPI | 1063462216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS9752) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101027855) |
| 207P00000X Emergency Medicine (Licence: IN 02007336A) | |
| 207P00000X Emergency Medicine (Licence: NY 234820) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2026-08-14 |