| NPI | 1780244061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT019498) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 011206) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-01-30 |