| NPI | 1376922468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D85510) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT208645) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2018-06-06 |