| NPI | 1912583923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD485359) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 32989) |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2024-07-01 |