| NPI | 1104120146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD218259) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT224647) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2024-10-28 |