| NPI | 1528417599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020901) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017243) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-08-15 |