| NPI | 1760635445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME116475) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 61096) |
| 207P00000X Emergency Medicine (Licence: PA mt188904) | |
| 207P00000X Emergency Medicine (Licence: SC 87395) | |
| 207R00000X Internal Medicine (Licence: PA mt188904) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2022-03-16 |