| NPI | 1700088051 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0014172) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 246730) | 
| 207P00000X Emergency Medicine (Licence: RI MD13996) | |
| Enumeration Date | 2007-05-31 | 
| Last Update Date | 2024-02-09 |