| NPI | 1760746960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 277887) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT202177) |
| 207P00000X Emergency Medicine (Licence: PA MD463496) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2018-05-08 |