| NPI | 1063654614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 50720) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT195142) |
| Enumeration Date | 2009-03-28 |
| Last Update Date | 2012-10-22 |