| NPI | 1306189915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0013792) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 291580) |
| 207P00000X Emergency Medicine (Licence: NM MD2015-0679) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2022-07-21 |