| NPI | 1932275625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: PA OS014257) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: PA FB6673885) |
| 208D00000X General Practice (Licence: PA PAOS013257) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2020-10-27 |