| NPI | 1134652928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 020743) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020743) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2019-12-16 |