| NPI | 1265631808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61098313) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME146794) |
| 207P00000X Emergency Medicine (Licence: TX N2632) | |
| 207P00000X Emergency Medicine (Licence: GA 059549) | |
| 207P00000X Emergency Medicine (Licence: CA A107549) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2026-07-09 |