| NPI | 1366653669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N5038) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57012067) |
| 207P00000X Emergency Medicine (Licence: KY 42546) | |
| 207P00000X Emergency Medicine (Licence: CT 1.049753) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2012-11-15 |