| NPI | 1487180410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 310165) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 282460) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-11-10 |