| NPI | 1689201386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 73566) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 341921) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-01-31 |