| NPI | 1649533621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 2751) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT014692) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2015-07-02 |