| NPI | 1881007367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS019776) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT016771) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2020-05-27 |