| NPI | 1124093356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD067917L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 31329) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2018-12-28 |