| NPI | 1184060741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 054822) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1026693) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2026-03-25 |