| NPI | 1457309619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 268189-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9900332) |
| 207Q00000X Family Medicine (Licence: NY 268189-1) | |
| 207Q00000X Family Medicine (Licence: NC 9900332) | |
| 207P00000X Emergency Medicine (Licence: RI 13867) | |
| 207Q00000X Family Medicine (Licence: RI 13867) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-04-11 |