| NPI | 1649887530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X (Licence: NY 370353) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 370353) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2020-09-25 |