| NPI | 1659620565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 281730) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 61521) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2022-07-21 |