| NPI | 1063906055 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD478227) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT215512) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2022-07-26 |