| NPI | 1104028547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 49336) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N0229) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CT 49336) | |
| 207P00000X Emergency Medicine (Licence: NY 235660) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2026-06-23 |