| NPI | 1669673695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2012-0752) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME106857) |
| 207P00000X Emergency Medicine (Licence: FL TRN11192) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2017-03-22 |