| NPI | 1396373585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1025723) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 320512-01) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-03-06 |