| NPI | 1639758303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 334150) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-16908) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-06-26 |