| NPI | 1619403243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS019765) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 304000-01) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2026-09-21 |