| NPI | 1003869470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD443721) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 232357) |
| 207P00000X Emergency Medicine (Licence: NJ 25ma07919200) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-10-29 |