| NPI | 1740910207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 337911) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT021987) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2025-06-29 |