| NPI | 1164626552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD439085) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C7-0003776) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2023-06-21 |