| NPI | 1407236250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS019396) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB10799500) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2025-05-22 |