| NPI | 1659057347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA PENDING) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT229965) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |