| NPI | 1083871057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO161554) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT012434) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2021-04-23 |