| NPI | 1609057652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 32542) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT190745) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2020-12-17 |