| NPI | 1578770350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 8443) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ND 13029) |
| 207P00000X Emergency Medicine (Licence: IA 38168) | |
| 207P00000X Emergency Medicine (Licence: OH 093647) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-09-23 |