| NPI | 1194106286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 51405) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT209136) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2018-09-06 |