| NPI | 1902817307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042-0008782) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 10082) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2016-03-23 |