| NPI | 1174886303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 65278) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT201274) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-05-04 |