| NPI | 1770551293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-00313) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME142699) |
| 207P00000X Emergency Medicine (Licence: PA MD426897) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2019-10-03 |