| NPI | 1023472909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 28012) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 53164) |
| 207P00000X Emergency Medicine (Licence: OH 35.137299) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2020-02-27 |