Individual
OO HTAIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-9837
Mailing address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-9837
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q8910
TX
Other
Enumeration date
03/27/2013
Last updated
08/14/2017
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