| NPI | 1194834226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 122168) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 122168) |
| 208D00000X General Practice (Licence: NY 122168) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-03-07 |