| NPI | 1861611279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301091418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 239122) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2009-10-08 |