| NPI | 1982778486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 171806) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS-006765-E) |
| 207P00000X Emergency Medicine (Licence: NC 02524) | |
| 207P00000X Emergency Medicine (Licence: CA 20A18353) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: SC 420) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2022-03-15 |