| NPI | 1790732998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD050134L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ MA59502) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-07-23 |