| NPI | 1568754331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD456797) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 054002) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2019-10-30 |