| NPI | 1609874858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD428228) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 20107) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-02-13 |