| NPI | 1831536440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 81176) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TPME4731) |
| 207P00000X Emergency Medicine (Licence: PA MD462733) | |
| 207R00000X Internal Medicine (Licence: LA 349655) | |
| 207P00000X Emergency Medicine (Licence: WI 4320-320) | |
| 207P00000X Emergency Medicine (Licence: NJ 25MA09815400) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2026-05-18 |