| NPI | 1134413867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 056295) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 274013-1) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NY 274013) | |
| 282N00000X General Acute Care Hospital | |
| 207P00000X Emergency Medicine (Licence: NY 274013) | |
| Enumeration Date | 2011-05-28 |
| Last Update Date | 2019-07-09 |