| NPI | 1972985299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101289415) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MA10245300) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 30830) | |
| 207P00000X Emergency Medicine (Licence: PA MD461810) | |
| 207P00000X Emergency Medicine (Licence: PA MT209074) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2026-07-28 |