| NPI | 1629148556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ME MD21552) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 162365) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 162365) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-10-22 |