| NPI | 1306289798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD457155) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 161260) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2016-12-28 |