| NPI | 1508436056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 336241-01) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS023151) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2025-07-28 |