| NPI | 1982265104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME155571) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT219379) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2022-05-05 |