| NPI | 1619013372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D68274) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD489517) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2026-01-29 |