| NPI | 1396987905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0012725) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 264668) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: ME MD24251) | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2020-10-26 |