| NPI | 1528370624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 50761) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 257745) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2012-04-06 |