| NPI | 1831161058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD441377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18595) |
| 207Q00000X Family Medicine (Licence: AL 26072) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2013-12-10 |