| NPI | 1376071001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04931) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2018-01812) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2024-02-07 |