| NPI | 1063774537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS016952) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 3291) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-01-27 |