| NPI | 1730471806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT014070) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD H0077224) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2025-05-08 |