| NPI | 1164953055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2020-01061) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4333) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-10-09 |