| NPI | 1104147867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-02260) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT197765) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-06-01 |