| NPI | 1164915682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD473803) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA11321600) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA MT215257) | |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2022-01-10 |