| NPI | 1972711810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME134402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS10286) |
| 207P00000X Emergency Medicine (Licence: NY 243904) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-06-12 |