| NPI | 1710944392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH LT-3150) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101046661) |
| 207R00000X Internal Medicine (Licence: VA 0101046661) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2022-11-02 |