| NPI | 1962439695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 11616) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 230239) |
| 208D00000X General Practice (Licence: CA C-203083) | |
| 208D00000X General Practice (Licence: RI MD20713) | |
| 208D00000X General Practice (Licence: CT 64723) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2025-07-03 |