| NPI | 1770552903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME 015486) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 251686) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-12-03 |