| NPI | 1790131134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 31757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD467052) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2024-01-10 |