| NPI | 1194130575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.130621) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD459101) |
| 207P00000X Emergency Medicine (Licence: PA MT205920) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2025-08-26 |