| NPI | 1083148837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 10960778-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 312199) |
| 207P00000X Emergency Medicine (Licence: VT 032-0133950) | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2021-12-15 |