| NPI | 1346536794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 277263) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 277185) |
| 207P00000X Emergency Medicine (Licence: NC 2014-01244) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2019-09-04 |