| NPI | 1568872570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288871) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2017028830) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2017-08-21 |