| NPI | 1922184084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101248231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 12827) |
| 207P00000X Emergency Medicine (Licence: SC 95719) | |
| 207P00000X Emergency Medicine (Licence: ME MD28150) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2025-12-03 |