| NPI | 1164611364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-02029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD47229) |
| 207P00000X Emergency Medicine (Licence: GA 082075) | |
| 207P00000X Emergency Medicine (Licence: OH 35.094565) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2021-11-24 |