| NPI | 1003065475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT192754) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 02250) |
| 207P00000X Emergency Medicine (Licence: WA MD60201428) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2022-02-17 |