| NPI | 1932660933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 320276) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 102996) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2025-12-11 |