| NPI | 1346730736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 301298) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 042.0017527) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2025-09-30 |