| NPI | 1477071280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 031161) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.005176RX) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2024-09-14 |