| NPI | 1568612620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS016786) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT012597) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2022-02-14 |