| NPI | 1063437465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 905) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 02668) |
| 207P00000X Emergency Medicine (Licence: OH 34-004725 T) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2018-05-15 |