| NPI | 1407144314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME123030) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PA MT200251) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2015-12-07 |