| NPI | 1093874471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C1-0013100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 187669) |
| 207P00000X Emergency Medicine (Licence: NC 29580) | |
| 207Q00000X Family Medicine (Licence: MA 266581) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2019-06-04 |