| NPI | 1548241227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 253887) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200200791) |
| 207P00000X Emergency Medicine (Licence: CT 044249) | |
| 207P00000X Emergency Medicine (Licence: NH 14358) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2013-11-30 |