| NPI | 1730591678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 3310) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT016094) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2023-08-23 |