| NPI | 1568403624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 288392-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34006556) |
| 207P00000X Emergency Medicine (Licence: PA OS010138L) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-07-21 |