| NPI | 1376953463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.013296) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015737) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2019-05-25 |