| NPI | 1134461312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301111831) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 3902000000x) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2020-02-05 |