| NPI | 1467717355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT202132) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101259919) |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2022-04-26 |