| NPI | 1265428197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD424700) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 301705-01) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2021-03-03 |