| NPI | 1386730711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD072378L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD072378L) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: PA MD072378L) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-11-19 |