| 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 |