| NPI | 1487812160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS013891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT011292) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2012-02-24 |