| NPI | 1891930897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS022512) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 252894-1) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2023-08-31 |