| NPI | 1518315639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020133) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017044) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2019-09-17 |