| NPI | 1578123618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 24432) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019129) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2023-09-28 |