| NPI | 1407081094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 273831-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 253070) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2018-01-10 |