| NPI | 1154768406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 300569) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 66109) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2026-05-14 |