| NPI | 1356604623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 284206) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 066433) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-07-31 |