| NPI | 1972504413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB05431100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS004892L) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2019-02-25 |