| NPI | 1639437338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.130942) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD15777) |
| 207P00000X Emergency Medicine (Licence: NY 288404) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2024-07-30 |