| NPI | 1326572637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 312699) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 78419) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA11278900) | |
| 207P00000X Emergency Medicine (Licence: WI 13437) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2026-07-09 |