| NPI | 1205864691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS021238P) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 201) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-09-16 |