| NPI | 1811060130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME112731) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 230419) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2021-06-04 |