| NPI | 1386809762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 43265) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT191326) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2025-09-09 |