| NPI | 1700293354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS017865) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID 6681510) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2026-07-08 |