| NPI | 1790166197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB10613100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2019-01720) |
| 207P00000X Emergency Medicine (Licence: AZ 010171) | |
| 207P00000X Emergency Medicine (Licence: GA 82460) | |
| 207P00000X Emergency Medicine (Licence: SC 83721) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2024-08-20 |