| NPI | 1497405377 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 34440) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 042.0018467) | 
| Enumeration Date | 2022-03-24 | 
| Last Update Date | 2025-10-10 |