| NPI | 1831190172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NY 20436001) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9500799) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-07-08 |