| NPI | 1912127580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 45247) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT188675) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2018-03-17 |