| NPI | 1083631683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102034358) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ MB 42440) |
| 207P00000X Emergency Medicine (Licence: PA OS-004961-L) | |
| 207Q00000X Family Medicine (Licence: VA 0102034358) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2017-04-12 |