| NPI | 1912261090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD480487) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R2901) |
| 207P00000X Emergency Medicine (Licence: NJ 25ma09683000) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-06-06 |