| NPI | 1104288190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 53824) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01084727A) |
| 207P00000X Emergency Medicine (Licence: OH 35.135394) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-06-08 |