| NPI | 1184207490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT222624) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M-17637) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2025-09-16 |