| NPI | 1942434535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 74967) |
| Additional Taxonomies | 2086S0129X (Licence: GA 74967) |
| 2086S0129X (Licence: NY 252887-1) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2021-04-21 |