| NPI | 1568459360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 11270) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD17109) |
| 207P00000X Emergency Medicine (Licence: PA MD441845) | |
| 207R00000X Internal Medicine (Licence: PA MD441845) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2019-09-13 |