| NPI | 1063034304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA 0S022747) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA OS022747) |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2024-04-01 |