| NPI | 1699747147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 112042) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 112042-1) |
| 207P00000X Emergency Medicine (Licence: NY 112042) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2011-05-16 |