| NPI | 1720382690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 260575) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A115358) |
| 207P00000X Emergency Medicine (Licence: CT 257080) | |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2021-11-29 |