| NPI | 1477935302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0014927) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT208572) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2020-09-21 |