| NPI | 1245723170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 253945) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 70902) |
| 207P00000X Emergency Medicine (Licence: PA OT018665) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2023-08-07 |