| NPI | 1124070545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 45940) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME152326) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2026-02-09 |