| 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 |