| NPI | 1235486838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS021842) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00289600) |
| 207P00000X Emergency Medicine (Licence: DE CE-0007077) | |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2022-07-04 |