| NPI | 1821483686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 294496) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 294496) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-07-22 |