| NPI | 1578122693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT019351) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3856) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2022-07-13 |