| NPI | 1336198654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0075767) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD448465) |
| 207P00000X Emergency Medicine (Licence: VA 0101253965) | |
| 207P00000X Emergency Medicine (Licence: NM 2002-0133) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2022-05-03 |