| NPI | 1619592169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 103070) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT220237) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2025-08-18 |