| NPI | 1881655546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.085260) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD042124E) |
| 207R00000X Internal Medicine (Licence: WV 18489) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2024-01-16 |