| NPI | 1609165687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS016916) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 275394) |
| 207P00000X Emergency Medicine (Licence: OH 34.011010) | |
| 207P00000X Emergency Medicine (Licence: NH 18767) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2023-08-01 |