| NPI | 1083058218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 267068) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 23136) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2025-11-20 |