| NPI | 1376806349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288830) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 288830) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2025-09-23 |