| NPI | 1225061633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9701633) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.153507) |
| 207P00000X Emergency Medicine (Licence: CT 83771) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2026-03-30 |