| NPI | 1811121593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101020213) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT013050) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2022-07-21 |