| NPI | 1225651169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD481017) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT220543) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-07-01 |