| NPI | 1629227145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 061570) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 193444-1) |
| 207P00000X Emergency Medicine (Licence: ME MD25476) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2023-06-22 |