| NPI | 1134489644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS017200) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT014453) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2015-12-28 |