| NPI | 1528799004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD486860) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX W2790) |
| 207P00000X Emergency Medicine (Licence: PA MT227359) | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2026-05-05 |