| NPI | 1154366623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME33922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME33922) |
| 207P00000X Emergency Medicine (Licence: PA MD038034L) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2015-04-19 |