| NPI | 1730384827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042-0012057) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 244610) |
| 207P00000X Emergency Medicine (Licence: HI MD-14525) | |
| 207P00000X Emergency Medicine (Licence: NJ 25MA08663800) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2010-09-09 |