| NPI | 1477820223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME114456) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 265761) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2014-02-12 |