| NPI | 1366934432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0017024) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 323789) |
| 207P00000X Emergency Medicine (Licence: MA 275399) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2025-09-26 |