| NPI | 1790751667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 78416) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 000446) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2015-12-10 |