| NPI | 1871507905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 331855) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F331855) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-12-29 |