| NPI | 1861785941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME136925) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 76071) |
| 207P00000X Emergency Medicine (Licence: NC 2014-01621) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2026-01-28 |