| NPI | 1891056594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB09834000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS023363) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2025-07-02 |