| NPI | 1669609046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT195799) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME124561) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2026-06-29 |