| NPI | 1326027103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 23196) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 23196) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2008-04-24 |