| NPI | 1548779390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT227370) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0010179) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |