| NPI | 1639733751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020970) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019010) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB11726600) | |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2023-04-17 |