| NPI | 1992939953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 269651-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 60842-20) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2016-08-09 |