| NPI | 1073870218 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME151199) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 283504) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2025-01-22 |