| NPI | 1235667072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT017898) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS020335) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2025-06-14 |