| NPI | 1770233769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 333302) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 333302) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-02-09 |