| NPI | 1104169812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 299648) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1021287) |
| 207P00000X Emergency Medicine (Licence: CT 56484) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2025-03-19 |