| NPI | 1679648232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301081618) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD433433) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-02-10 |