| NPI | 1356791115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD471322) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10056694) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-08-09 |