| NPI | 1104355197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: PA OS026011) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS026011) |
| 207Q00000X Family Medicine (Licence: NJ 25MB10794700) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2026-07-07 |