| NPI | 1962427211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101245339) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 221468) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2026-08-28 |