| NPI | 1801050257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 112682) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS014161) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2014-02-14 |