| NPI | 1922237064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 262380) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 254070) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2013-02-14 |