| NPI | 1215420971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD474682) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA10890100) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-06-19 |