| NPI | 1821259979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 255612) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 255612) |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2012-09-20 |