| NPI | 1801803937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 239012) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 289972) |
| 207P00000X Emergency Medicine (Licence: CT 69249) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-11-02 |