| NPI | 1699941757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.010784) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX W2872) |
| 207P00000X Emergency Medicine (Licence: IN 02004145A) | |
| 207P00000X Emergency Medicine (Licence: PA OT012486) | |
| 207Q00000X Family Medicine (Licence: PA OT012486) | |
| 207P00000X Emergency Medicine (Licence: PA OS014910) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2026-03-13 |