| NPI | 1639810708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD487931) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0103515) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-10-06 |