| NPI | 1669761912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY TL2562) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 7973983) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2016-10-04 |