| NPI | 1184975039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL MD141456) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 280440) |
| 207P00000X Emergency Medicine (Licence: FL MD141456) | |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2021-12-08 |