| NPI | 1609108505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME126242) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 256081) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2016-03-31 |