| NPI | 1053761288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 78707) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2019017049) |
| Enumeration Date | 2016-06-19 |
| Last Update Date | 2024-06-27 |