| NPI | 1003234584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 49897) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 390200000) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2017-07-25 |