| NPI | 1134781297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 074147) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019636) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-11-11 |