| NPI | 1154784007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD469677) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C1-0013009) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2020-08-03 |