| NPI | 1720073901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 207386) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 042471) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2012-04-28 |