| NPI | 1376905091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82379) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME159410) |
| 207P00000X Emergency Medicine (Licence: NY 320069) | |
| 207P00000X Emergency Medicine (Licence: NJ 25MA13112200) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-07-01 |