| NPI | 1255536165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 201300437) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 059817) |
| 207P00000X Emergency Medicine (Licence: PA MD430239) | |
| 207P00000X Emergency Medicine (Licence: IL 336.079381) | |
| 207P00000X Emergency Medicine (Licence: WV 33170) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2023-12-06 |