| NPI | 1720215627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 85171-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT195169) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2025-02-05 |