| NPI | 1578587341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 037212) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 210137) |
| 207P00000X Emergency Medicine (Licence: RI 11620) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 210137) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NY 210137) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2010-08-07 |