| NPI | 1447639562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD472043) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 140221) |
| 207P00000X Emergency Medicine (Licence: GA 83489) | |
| 207P00000X Emergency Medicine (Licence: KY 52497) | |
| 207P00000X Emergency Medicine (Licence: NY 294505) | |
| 207P00000X Emergency Medicine (Licence: TN 0000059133) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2020-10-14 |