| NPI | 1063627859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD661357832) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 333118-8905) |
| 207P00000X Emergency Medicine (Licence: WV 34451) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-09-08 |