| NPI | 1912994815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 63938) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MA 74916) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-01-15 |