| NPI | 1851654966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301113830) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT201280) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA11085700) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2021-06-30 |