| NPI | 1043213820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 33994) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 33994) |
| 207R00000X Internal Medicine (Licence: KY 33994) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2013-06-07 |