| NPI | 1871889188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0077506) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT200041) |
| 207P00000X Emergency Medicine (Licence: DC MD045983) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2020-02-06 |