| NPI | 1346218989 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 045454)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD10659)  | 
| Enumeration Date | 2006-03-09 | 
| Last Update Date | 2008-08-19 |