| NPI | 1205864675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101242440) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD070350L) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-01-08 |