| NPI | 1518106871 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD445231)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 27541)  | 
| 207P00000X Emergency Medicine (Licence: NH LT4402)  | |
| 207R00000X Internal Medicine (Licence: PA MD445231)  | |
| Enumeration Date | 2009-02-10 | 
| Last Update Date | 2024-12-30 |