| NPI | 1902933260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD480127) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 044856) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2023-03-27 |