| NPI | 1750413464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 032.0134276) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25mb05752300) |
| 207P00000X Emergency Medicine (Licence: NJ 25mb05752300) | |
| 207P00000X Emergency Medicine (Licence: NY 210336) | |
| 207P00000X Emergency Medicine (Licence: KY 04283) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2026-02-04 |