| NPI | 1992154223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: FL 23698) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 296974) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2026-05-05 |