| NPI | 1336634054 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB11207000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT018782) |
| 207P00000X Emergency Medicine (Licence: PA OS021255) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2025-01-14 |