| NPI | 1861657520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 256869) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT190171) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-06-07 |