| NPI | 1275743924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 250052) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 60 247121) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2023-07-10 |