| NPI | 1457709776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 70469) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT211114) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2019-07-22 |