| NPI | 1659435345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00013556) |
| Additional Taxonomies | 261QP2400X Clinic/Center, Prison Health (Licence: FL ME56576) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2025-09-09 |