| NPI | 1063771814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 50063) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT014549) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2016-12-15 |