| NPI | 1568732394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME111899) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 263913) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-04-05 |