| NPI | 1124068580 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD072729L) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA MD072729L) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2008-08-10 |