| NPI | 1164423174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 28975) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01084307A) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-05-27 |