| NPI | 1679735757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD443392) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI L2287382) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-06-10 |