| NPI | 1902302078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 96900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 315108) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-08-28 |