| NPI | 1760641633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 104004) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 251056) |
| 207P00000X Emergency Medicine (Licence: NE 28694) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2025-09-10 |