| NPI | 1891792123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 291566) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ NJDCATEMP-049079) |
| 207P00000X Emergency Medicine (Licence: PA MD068674L) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2023-11-10 |