| NPI | 1750815643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 86929) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 304457) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2021-12-19 |