| NPI | 1912341868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2015-02308) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015096) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2016-05-31 |