| NPI | 1669732558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 87937) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT014531) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-06-29 |