| NPI | 1831423300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 281970-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD443646) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2025-09-08 |