| NPI | 1063668101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2011-0175) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT192581) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2014-11-10 |