| NPI | 1992753198 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ MB080476) | 
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA OT010151) | 
| Enumeration Date | 2006-05-04 | 
| Last Update Date | 2009-12-14 |