| NPI | 1083107460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 52547) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 313147) |
| 207P00000X Emergency Medicine (Licence: SC LL52547) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2022-10-31 |