| NPI | 1225444516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 304303) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 21037) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB10861600) | |
| 207P00000X Emergency Medicine (Licence: MI 5101025677) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2024-03-21 |