| NPI | 1366839995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS019010) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT016316) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2019-03-12 |