| NPI | 1255303673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 287752) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 060141) |
| 207P00000X Emergency Medicine (Licence: LA #MD 023467) | |
| 207P00000X Emergency Medicine (Licence: NH 14141) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2023-07-17 |