| NPI | 1053517664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 276967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 36227) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2015-08-17 |