| NPI | 1659940112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1018202) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT223864) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2024-04-02 |