| NPI | 1053713115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 289667) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 50552) |
| 207P00000X Emergency Medicine (Licence: RI MD17431) | |
| Enumeration Date | 2014-09-20 |
| Last Update Date | 2021-07-15 |