| NPI | 1942720040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT018116) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-15218) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2026-05-04 |