| NPI | 1194949024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 32450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 32450) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2017-08-10 |