| NPI | 1700319357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 306412) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101270117) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2022-05-11 |