| NPI | 1407588650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS024575) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT021860) |
| 207Q00000X Family Medicine (Licence: PA OT021860) | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-04-09 |