| NPI | 1992791586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL me90360) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 228221-1) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2021-03-15 |