| NPI | 1447630462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY TP850) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2017-00307) |
| 207P00000X Emergency Medicine (Licence: NM MD2018-0737) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2026-04-09 |