| NPI | 1366835563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS023994) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT020611) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2025-07-14 |