| NPI | 1760648380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 76217) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60130275) |
| 207P00000X Emergency Medicine (Licence: IL 125051804) | |
| 207P00000X Emergency Medicine (Licence: NY 60 286957) | |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2023-11-16 |