| NPI | 1255625745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 273115) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 265921) |
| 363L00000X Nurse Practitioner (Licence: NY 273115) | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2023-07-07 |