| NPI | 1609613157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS025571) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT023807) |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2026-07-20 |