| NPI | 1124689674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT019325) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB11527200) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2022-07-13 |