| NPI | 1629639976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS023654) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T6586) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB12100300) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 207PE0004X) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2025-08-12 |