| NPI | 1194173310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2019-02751) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017086) |
| 207P00000X Emergency Medicine (Licence: PA OS020070) | |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2022-04-19 |