| NPI | 1831132745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60937815) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 41816) |
| 207P00000X Emergency Medicine (Licence: CA A49642) | |
| 207P00000X Emergency Medicine (Licence: IN 01045167A) | |
| 207R00000X Internal Medicine (Licence: OH 35.095040) | |
| 207P00000X Emergency Medicine (Licence: OH 35.095040) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA MD040748L) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-10-24 |