| NPI | 1558548156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 60774163) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB08253300) |
| 207P00000X Emergency Medicine (Licence: NC 2008-00763) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2026-07-09 |