| NPI | 1609497874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO219019) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019837) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-06-03 |