| NPI | 1013151018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1016080) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT194587) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA09260000) | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2023-07-17 |