| NPI | 1124510219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 312472) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2022-07-14 |