| NPI | 1790995934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD436294) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 291510) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA MD436294) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-11-16 |