| NPI | 1629411079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 277570) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 60627150) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2016-07-19 |