| NPI | 1255727954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101273474) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD471193) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA10267200) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2022-12-30 |