| NPI | 1922539063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1015824) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD470816) |
| 207P00000X Emergency Medicine (Licence: NY 304423) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-07-17 |