| NPI | 1528266681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7086) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NY 244825) |
| 208D00000X General Practice (Licence: NY 244825) | |
| 207P00000X Emergency Medicine (Licence: NY 244825) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2013-07-31 |