| NPI | 1902211352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD462678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101264204) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-04-29 |