| NPI | 1265474019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME130720) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ MA68942) |
| 207P00000X Emergency Medicine (Licence: GA 057983) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-05-26 |