| NPI | 1801890140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD420038) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME95611) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2025-08-11 |