| NPI | 1366499378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 85955) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD070002L) |
| 207Q00000X Family Medicine (Licence: PA MD070002L) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2025-08-26 |