| NPI | 1912637752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 60943) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT226839) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2025-10-06 |