| NPI | 1962638213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-00764) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 104060) |
| 207P00000X Emergency Medicine (Licence: OH 35.152518) | |
| 207P00000X Emergency Medicine (Licence: NC 157552) | |
| 207P00000X Emergency Medicine (Licence: IN 01071179A) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2025-04-28 |