| NPI | 1902426042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 036168781) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 319411) |
| Enumeration Date | 2020-04-18 |
| Last Update Date | 2025-10-13 |