| NPI | 1558346635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 189196) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME118360) |
| 207P00000X Emergency Medicine (Licence: VA 0101280397) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2025-10-08 |