| NPI | 1639338940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 80993) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD453239) |
| 207P00000X Emergency Medicine (Licence: OH 35.097983) | |
| 207P00000X Emergency Medicine (Licence: WI 53475-20) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2026-10-12 |