| NPI | 1407291594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 49524) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP209) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2016-09-19 |