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 |