| NPI | 1811987936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 60138) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A84332) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 227564) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2025-10-24 |