| NPI | 1871604033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A88129) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 23883) |
| 207P00000X Emergency Medicine (Licence: FL ME164212) | |
| 207P00000X Emergency Medicine (Licence: OH 35.154329) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-07-17 |