| NPI | 1144229006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 264672) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200200903) |
| 207P00000X Emergency Medicine (Licence: CT 48064) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-07-23 |