| NPI | 1205332483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD477052) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301504086) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-08-03 |