| NPI | 1760418289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101272587) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35121102) |
| 207P00000X Emergency Medicine (Licence: PA MD070462L) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2025-09-02 |