| NPI | 1427258896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 28117) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME122599) |
| 207P00000X Emergency Medicine (Licence: LA MD.202472) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2026-08-12 |