| NPI | 1922560143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 316575) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1023875) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2026-08-03 |