| NPI | 1831431402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 269728) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 309025) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2023-07-07 |