| NPI | 1336534486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2019-01275) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017327) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2022-08-02 |