| NPI | 1215223920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT014179) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC DO37607) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2015-06-16 |