| NPI | 1891901708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-01439) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT188928) |
| 207P00000X Emergency Medicine (Licence: SC 31534) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2012-06-21 |