| NPI | 1073938577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 0010-07792) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22426) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-07792) | |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2025-06-09 |