| NPI | 1063964666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS15034) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 299267) |
| 207Q00000X Family Medicine (Licence: FL OS15034) | |
| Enumeration Date | 2016-10-30 |
| Last Update Date | 2022-03-09 |