| NPI | 1811929482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 235651) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD428742) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 235651) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-05-31 |