| NPI | 1679923403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 291056) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD467229) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2022-07-13 |