| NPI | 1801457361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 22725) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT219366) |
| 207P00000X Emergency Medicine (Licence: VT 042.0016079) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2022-10-19 |