| NPI | 1790972396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA mt191513) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 43367) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2025-01-31 |