| NPI | 1790743789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD422193) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C10007110) |
| 207P00000X Emergency Medicine (Licence: MD D0061147) | |
| 207P00000X Emergency Medicine (Licence: NY 236078) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2019-07-02 |