| NPI | 1861804726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS019678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3202) |
| 208D00000X General Practice (Licence: WV 3202) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2019-09-28 |