| NPI | 1538363460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-01888) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS014655) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2015-04-13 |