| NPI | 1164486999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD420918) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: PA MD420918) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-07-31 |