| NPI | 1386635043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0068042) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 95-01361) |
| 207P00000X Emergency Medicine (Licence: AL 16986) | |
| 207P00000X Emergency Medicine (Licence: PA MD-051984-L) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2023-03-07 |