| NPI | 1356350417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 22125) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 34182) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2021-04-13 |