| NPI | 1356624530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD455481) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301098259) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2015-08-19 |