| NPI | 1760643829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD442678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA mt192345) |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2011-10-18 |