| NPI | 1386381952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2026-01473) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS024469) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 2026-01473) | |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2026-06-30 |