| NPI | 1922195429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NY 172962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 172960) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2023-09-05 |