| NPI | 1558461160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA MD021932E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD021932E) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2011-05-09 |