| NPI | 1386291185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 025695) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 055.0031486) |
| 207P00000X Emergency Medicine (Licence: NC 0010-09362) | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2023-06-28 |