NPI | 1639733751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020970) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB11726600) |
207PS0010X Emergency Medicine, Sports Medicine (Licence: NJ 25MB11726600) | |
207P00000X Emergency Medicine (Licence: PA OT019010) | |
Enumeration Date | 2019-04-24 |
Last Update Date | 2024-07-11 |