| NPI | 1578755120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 245348) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25ma08257900) |
| 207P00000X Emergency Medicine (Licence: AZ 75204) | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2025-09-11 |