| NPI | 1639367725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 246593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301091092) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2009-01-22 |