| NPI | 1760595219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: PA MD045042L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD045042L) |
| 207Q00000X Family Medicine (Licence: PA MD045042L) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-04-09 |