| NPI | 1831367069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 258600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT011419) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2015-09-01 |