| NPI | 1215563705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: NY 331382) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 331382) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2025-07-21 |