| NPI | 1003173238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 279565) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI E420229009739) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2015-08-19 |