| NPI | 1639598659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042-0014368) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 298721) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VT 042-0014368) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 298721) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2026-04-03 |