| NPI | 1053595728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD432079) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA MD430279) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2018-01-05 |