| NPI | 1841604501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0084902) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA mt206669) |
| 207R00000X Internal Medicine (Licence: PA MT206669) | |
| 207P00000X Emergency Medicine (Licence: WV 30079) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2021-04-29 |