| NPI | 1730179979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 32048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD030502E) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2025-04-22 |