| NPI | 1538143755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 21966) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 41256) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2021-04-13 |