| NPI | 1174967293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS017670) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015044) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2016-08-31 |