| NPI | 1902168792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A136911) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 317275) |
| 207P00000X Emergency Medicine (Licence: VT 042.0016418) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2026-03-09 |