| NPI | 1225295256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME120096) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP785) |
| 207P00000X Emergency Medicine (Licence: NC 149035) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2026-06-29 |