| NPI | 1790944601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO158057) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 248248) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2012-08-28 |