| NPI | 1023213717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 047369) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 248028) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2010-12-17 |