| NPI | 1629469390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT215698) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA11095900) |
| 207P00000X Emergency Medicine (Licence: PA MD471957) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2025-07-14 |