| NPI | 1336307156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 2574) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT012653) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WV 2574) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2018-03-17 |