| NPI | 1962766477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 61321) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD457701) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2018-06-12 |