| NPI | 1306933114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 04408) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04408) |
| 207P00000X Emergency Medicine (Licence: PA os 011041) | |
| 207P00000X Emergency Medicine (Licence: NJ 25MB08169500) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2026-01-08 |