| NPI | 1679991012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 078169) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 307973) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2021-01-06 |