| NPI | 1518499813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1022770) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 65289) |
| 207P00000X Emergency Medicine (Licence: PA MD473834) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2025-06-05 |