| NPI | 1659955342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS025734) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT020713) |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2026-07-20 |