| NPI | 1548207863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS11375) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 203654) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-03-06 |