| NPI | 1205221025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD462036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 299397) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-03-02 |