| NPI | 1255390373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 56253) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME89798) |
| 207P00000X Emergency Medicine (Licence: NJ 031470) | |
| 207P00000X Emergency Medicine (Licence: SC 36333) | |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2023-06-08 |