| NPI | 1669496154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 240028) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2006-00852) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-05-27 |