| NPI | 1104934348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA08904500) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 38397) |
| 207P00000X Emergency Medicine (Licence: PA MD-065522-L) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2017-04-19 |