| NPI | 1528408671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 287302) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 73082) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2023-07-13 |