| NPI | 1386908481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME127402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301101655) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA09705300) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2026-04-30 |