| NPI | 1477040392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042-0016240) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 318447) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2025-10-02 |