| NPI | 1780188474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 32471) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD473506) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-04-10 |