| NPI | 1912466970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS022797) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD H0095564) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB11385700) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MB11385700) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA OS022797) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-10-03 |