| NPI | 1891291738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1018423) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 316105) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2026-01-30 |