| NPI | 1669033254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 13339684-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019562) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2023-06-25 |