| NPI | 1265483697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042-0006167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 9072) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |