| NPI | 1447449632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 44416) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.092687) |
| 207P00000X Emergency Medicine (Licence: IN 01068437A) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2021-06-02 |