| NPI | 1013273853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY TP595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116024155) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2015-08-07 |