| NPI | 1457588618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY C1999) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2012-01672) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2024-03-05 |