| NPI | 1396841623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 14898A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME99936) |
| 208000000X Pediatrics (Licence: FL ME99936) | |
| 207R00000X Internal Medicine (Licence: FL ME99936) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2025-10-23 |