| NPI | 1679062590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 310336-01) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 14202-0000) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-02-01 |