| NPI | 1316169238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 268288) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT189123) |
| 207P00000X Emergency Medicine (Licence: PA MD436616) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 144070) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-07-07 |