| NPI | 1720149107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 045447) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT182915) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-13 |