| NPI | 1063499077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 045753) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34008292) |
| 207P00000X Emergency Medicine (Licence: NY 314805) | |
| 207P00000X Emergency Medicine (Licence: RI DO00643) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2023-08-31 |