| NPI | 1568449874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD422589) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD422589) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2025-02-12 |