| NPI | 1750508297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 244821) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: PA MD430663) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2008-06-12 |