| NPI | 1366891327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.138859) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT210709) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-10-22 |