| NPI | 1417319260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1022806) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 62472) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-06-18 |