| NPI | 1508151473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 280756) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 258649) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2015-07-25 |