| NPI | 1548622160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 68660) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 304173) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-03-31 |