| NPI | 1679002075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2021-02018) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017920) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |