| NPI | 1942258934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 218592) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 218592) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2026-07-27 |