| NPI | 1144434614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL TRN11389) |
| Additional Taxonomies | 2080H0002X (Licence: PA MT185033) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2010-01-22 |