| NPI | 1811217573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI 16985) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT197912) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2015-12-16 |