| NPI | 1366947210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 312779) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 82935) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2026-06-08 |