| NPI | 1407889462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042-0010979) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 15147) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2018-12-03 |