| NPI | 1760612840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 265325) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A113895) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2023-09-22 |