| NPI | 1124330345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 87000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV CL0796) |
| 207P00000X Emergency Medicine (Licence: OH 34.011360) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2026-01-12 |