| NPI | 1679070932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 309818-01) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 309818) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2021-10-01 |