| NPI | 1811064587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 160381-1) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 160381-1) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2011-03-17 |