| NPI | 1104171198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 265814) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA09260400) |
| 207P00000X Emergency Medicine (Licence: CA C198901) | |
| 207P00000X Emergency Medicine (Licence: CO CDRH.0061750) | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2026-05-04 |