| NPI | 1053342600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 19288) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 228601) |
| 207Q00000X Family Medicine (Licence: NY 228601) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2024-05-08 |