| NPI | 1790192516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 298824) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 15256) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2019-08-01 |