| NPI | 1871602318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 045480) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD429505) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-07-21 |