| NPI | 1912992967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 244670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD428233) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2008-03-28 |