| NPI | 1013594464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 338436) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1019452) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-07-28 |