| NPI | 1407238363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME135904) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.149531) |
| 207P00000X Emergency Medicine (Licence: PA MT208368) | |
| 207P00000X Emergency Medicine (Licence: KY c4277) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2026-03-14 |