| NPI | 1992055842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 2992) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS017822) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2021-12-07 |