| NPI | 1588067995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0017897) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 332169) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2024-10-28 |