| NPI | 1083076145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 57957) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4189) |
| 207P00000X Emergency Medicine (Licence: TN 59845) | |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2023-10-03 |