| NPI | 1104106236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101255772) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 266554) |
| Enumeration Date | 2011-08-20 |
| Last Update Date | 2022-04-04 |