| NPI | 1952715336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS022323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS15356) |
| 207P00000X Emergency Medicine (Licence: PA OT015805) | |
| 208D00000X General Practice (Licence: NY 286936) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2023-01-02 |