| NPI | 1902832751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME MD17213) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD427442) |
| 207P00000X Emergency Medicine (Licence: NH 14432) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-04-13 |