| NPI | 1902102767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2016020747) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 60 265574) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2016-07-25 |