| NPI | 1649900325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT226823) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA MT226823) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2022-06-15 |