| NPI | 1063626695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD430801) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 277349) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-02-25 |