| NPI | 1457356776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 20087) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP675) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 34007056d) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: KY tp675) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2020-10-16 |