| NPI | 1205284429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS019237) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017045) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2019-07-02 |