| NPI | 1801325063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD470744) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT214057) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2021-01-29 |