| NPI | 1508027434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 249018) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 30735) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 249018) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2021-12-24 |