| NPI | 1770757718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-32972) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT185966) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2015-04-21 |