| NPI | 1801231261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 36878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 277923) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2025-06-18 |