| NPI | 1164407854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 107900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 45667) |
| 207P00000X Emergency Medicine (Licence: TX D5606) | |
| 207P00000X Emergency Medicine (Licence: MO 2012003308) | |
| 207P00000X Emergency Medicine (Licence: IN 01022165A) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2019-03-05 |