| NPI | 1104864107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 32827) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 32827) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2007-07-08 |