| NPI | 1821653387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS022020) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019027) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2022-06-13 |