| NPI | 1578721866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 45465) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01068464A) |
| 207P00000X Emergency Medicine (Licence: PA MT188168) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2014-05-02 |