| NPI | 1093343410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME MD28715) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 390200000X) |
| 207P00000X Emergency Medicine (Licence: NY 323157) | |
| 207P00000X Emergency Medicine (Licence: MI 4301511001) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-10-08 |