| NPI | 1740340587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 260037-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010006) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2018-05-16 |