| NPI | 1023000916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 232483) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 042.0018688) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2026-01-23 |