| NPI | 1770160822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0018435) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 335168) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-09-05 |