| NPI | 1255714622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME MD22688) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT209640) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2021-01-05 |