| NPI | 1649520065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 81744) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 278383) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2018-12-26 |