| NPI | 1417417643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 85708) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD482057) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-06-26 |