| NPI | 1447646294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102205547) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 290744) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2019-06-12 |