| NPI | 1336777481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 82303) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 323821) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-06-26 |