| NPI | 1457552531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME107974) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX W2160) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT189233) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2026-09-29 |