| NPI | 1376287300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB13229700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT021728) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2026-08-05 |