| NPI | 1164707592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 68789) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 264342) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2014-06-06 |