| NPI | 1306815535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 28188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD070369L) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2021-03-16 |