| NPI | 1144299686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 207579-1) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NY 207579) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2012-07-12 |