| NPI | 1770046997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 10772) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 317171) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2022-08-01 |