| NPI | 1396476750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 74468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT227159) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2025-07-22 |