| NPI | 1679987374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT206816) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 19383) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2025-03-14 |