| NPI | 1235429333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 48123) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.122526) |
| 207P00000X Emergency Medicine (Licence: IN 01084665A) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2021-05-27 |