| NPI | 1124229331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD437910) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD45044) |
| 207P00000X Emergency Medicine (Licence: VA 0101245487) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-02-17 |