| NPI | 1780819771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 9463450-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT012855) |
| 207P00000X Emergency Medicine (Licence: GA 070013) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: GA 070013) | |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2022-07-28 |