| NPI | 1104972207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 12794) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R1216) |
| 207P00000X Emergency Medicine (Licence: OH 35.122205) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-08-08 |