| NPI | 1285658666 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 42277) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 240613) | 
| Enumeration Date | 2006-07-27 | 
| Last Update Date | 2022-07-26 |