| NPI | 1225394240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME0128785) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 279289) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2025-05-30 |