| NPI | 1568873164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 61836) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 293844) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2020-06-04 |