| NPI | 1821403890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 79342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 273951) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2022-11-02 |