| NPI | 1225569742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME176985) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD467868) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2025-12-03 |