| NPI | 1023169968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME103918) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN10220) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2022-10-20 |