| NPI | 1073713921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT012286) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS014918) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2021-05-03 |