| NPI | 1538461132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 280228) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 18311) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2015-06-15 |