| NPI | 1851887624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 89262) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 89262) |
| 208D00000X General Practice (Licence: SD 17850) | |
| 208D00000X General Practice (Licence: MS 35982) | |
| 208D00000X General Practice (Licence: IA MD-55839) | |
| 208D00000X General Practice (Licence: FL ME150171) | |
| 207P00000X Emergency Medicine (Licence: NV 28236) | |
| 207P00000X Emergency Medicine (Licence: MN 80917) | |
| 208D00000X General Practice (Licence: NV 28236) | |
| 207P00000X Emergency Medicine (Licence: SD 17850) | |
| 207P00000X Emergency Medicine (Licence: IA MD-55839) | |
| 208D00000X General Practice (Licence: MN 80917) | |
| 207P00000X Emergency Medicine (Licence: MS 35982) | |
| 207P00000X Emergency Medicine (Licence: FL ME150171) | |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2025-11-05 |