| NPI | 1659778892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT233576) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038440-1) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2025-04-22 |