| NPI | 1770013799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME MD29521) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT214237) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-07-21 |