| NPI | 1366456386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 06453) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34008670) |
| 207P00000X Emergency Medicine (Licence: KY 03163) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-03-19 |