| NPI | 1104111954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D77190) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT#199152) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2014-08-07 |