| NPI | 1912070988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD073734L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.097214) |
| 207Q00000X Family Medicine (Licence: PA MD073734L) | |
| 207R00000X Internal Medicine (Licence: PA MD073734L) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-06-04 |