| NPI | 1720071277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 25559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD22311) |
| 207Q00000X Family Medicine (Licence: NJ 25MA10015400) | |
| 207P00000X Emergency Medicine (Licence: IN 01078315A) | |
| 207P00000X Emergency Medicine (Licence: WI 1987320) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2025-09-15 |