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 |