| NPI | 1003869470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD443721) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA07919200) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-07-15 |