| NPI | 1134782618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 321109) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 81684) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-07-02 |