| NPI | 1174785505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 2601946) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34C.000334) |
| 207P00000X Emergency Medicine (Licence: TX W1698) | |
| 207P00000X Emergency Medicine (Licence: KY C5090) | |
| 207P00000X Emergency Medicine (Licence: WA OP61492300) | |
| 207P00000X Emergency Medicine (Licence: FL 23020) | |
| 207P00000X Emergency Medicine (Licence: AZ 010702) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2026-02-27 |