| NPI | 1861656076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD452506) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA09726300) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2025-02-18 |