| NPI | 1205247079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 333730) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102206000) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2025-06-11 |