| NPI | 1467740191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 281890) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2040) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: GU M-2040) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2021-04-25 |