| NPI | 1073861324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT202612) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 042.0013266) |
| 207P00000X Emergency Medicine (Licence: NH 17136) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2021-09-01 |