| NPI | 1508021502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 005245) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 247206) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2009-11-10 |