| NPI | 1063778553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.011190) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS017479) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2022-07-01 |