| NPI | 1063708766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS016425) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME LT4005) |
| 207P00000X Emergency Medicine (Licence: PA OT014189) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2024-07-10 |