| NPI | 1629502364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME143889) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.138361) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2026-11-09 |