| NPI | 1093160541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT212259) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 292106) |
| 207P00000X Emergency Medicine (Licence: PA MD465904) | |
| 207Q00000X Family Medicine (Licence: PA MD465904) | |
| 207Q00000X Family Medicine (Licence: NY 292106) | |
| 207Q00000X Family Medicine (Licence: PA MT212259) | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2021-03-04 |