| NPI | 1770522872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME88325) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 215873) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-11-16 |