| NPI | 1477967008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 64352) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015815) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2019-01-17 |