| NPI | 1225078157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 39137) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 27164) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2017-07-24 |