| NPI | 1265164214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2025008826) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025008826) |
| 207P00000X Emergency Medicine (Licence: NY 327868) | |
| 207P00000X Emergency Medicine (Licence: PA OT022170) | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2026-03-24 |