| NPI | 1598714578 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL os11198)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25mb07360200)  | 
| Enumeration Date | 2006-05-08 | 
| Last Update Date | 2012-02-03 |