| NPI | 1720512361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 314926) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME MD25906) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2024-06-19 |