| NPI | 1053804583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS021322) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT018573) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2021-07-22 |