| NPI | 1740223205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ME 1419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 240810) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-01-20 |