| NPI | 1750731147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME MD28539) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT210746) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2025-01-21 |