| NPI | 1629509294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD470866) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C1-0024688) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2026-06-29 |