| NPI | 1700521176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS024309) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX W0590) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB12800200) | |
| Enumeration Date | 2022-04-30 |
| Last Update Date | 2026-04-09 |