| NPI | 1871518118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 248582) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 14173) |
| 207P00000X Emergency Medicine (Licence: MA 237828) | |
| 207P00000X Emergency Medicine (Licence: CO 49297) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-04-24 |