| NPI | 1770903312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 300033) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS019352) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2021-01-15 |