| NPI | 1679750483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 005625) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT011842) |
| 207Q00000X Family Medicine (Licence: PA OT011842) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2014-06-04 |