| NPI | 1013211168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 259532-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 286222) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2021-06-04 |