| NPI | 1780824300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME 018197) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT188759) |
| Enumeration Date | 2009-02-22 |
| Last Update Date | 2014-11-21 |