| NPI | 1952698243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60453867) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT200154) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2014-09-22 |