| NPI | 1366742678 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME126449) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA09219600) | 
| 207P00000X Emergency Medicine (Licence: NC 2013-00110) | |
| Enumeration Date | 2010-11-02 | 
| Last Update Date | 2020-04-10 |