| NPI | 1043874613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME163053) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2022-00518) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2023-07-27 |