| NPI | 1164978144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 01088108B) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.139673) |
| 282N00000X General Acute Care Hospital (Licence: TX BP10057618) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2022-08-25 |