| NPI | 1093379398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD488305C) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 322646) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA11836900) | |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2026-08-28 |