| NPI | 1801957063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 257069) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 39020000x) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2024-05-22 |