| NPI | 1902065535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD152718) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 256569) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2011-08-18 |