| NPI | 1164650438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.206167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 253698) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2014-05-21 |