| NPI | 1407111685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: KY 51762) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 51762) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2018-11-05 |