| NPI | 1417576745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 322739) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD489578) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-07-08 |