| NPI | 1780180653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 65848) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 29149) |
| 207P00000X Emergency Medicine (Licence: PA MD474750) | |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2022-07-28 |