| NPI | 1255326070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME90745) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 13295) |
| 207P00000X Emergency Medicine (Licence: NC 2026-01396) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2026-05-28 |