| NPI | 1649699125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 318993) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA ML 60475779) |
| 207P00000X Emergency Medicine (Licence: WA MD.MD.60675887) | |
| 207P00000X Emergency Medicine (Licence: VT 042.0016494) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-02-13 |