| NPI | 1073554176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME102927) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 88224) |
| 207P00000X Emergency Medicine (Licence: PA MD051077L) | |
| 207P00000X Emergency Medicine (Licence: NJ MA60455) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2024-03-07 |