| NPI | 1992333249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 321458) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1024933) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-08-25 |