| NPI | 1972913663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 300617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021043) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2019-08-12 |