| NPI | 1982658092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 305178) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9400158) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2025-06-12 |