| NPI | 1881758993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 189250) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 39664) |
| 207P00000X Emergency Medicine (Licence: TN 58773) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2025-09-09 |