| NPI | 1083059604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 67107-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015080) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2021-12-28 |