| NPI | 1629694708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 320248-01) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 320248-01) |
| 208D00000X General Practice (Licence: NY 320248-01) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-05-12 |