| NPI | 1609018860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OR MD160709) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD160709) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: OR MD160709) | |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2026-03-06 |