| NPI | 1558523829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 265435-01) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT012328) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2021-06-15 |