| NPI | 1689235764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME162457) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 253852) |
| 207P00000X Emergency Medicine (Licence: PA MT218934) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-10-19 |