| NPI | 1609969534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 292448-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD055936L) |
| 207P00000X Emergency Medicine (Licence: WY 15261A) | |
| 207P00000X Emergency Medicine (Licence: PA MD055936L) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-05-29 |