| NPI | 1124384706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 15632C) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.124397) |
| 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-105343) | |
| 207P00000X Emergency Medicine (Licence: CA A137561) | |
| 207P00000X Emergency Medicine (Licence: MI 4301106739) | |
| 207P00000X Emergency Medicine (Licence: NV 16167) | |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2025-12-08 |