| NPI | 1346695012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD467614) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 299907) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2023-02-08 |