| NPI | 1093095887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA OT014878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014878) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2013-01-30 |