| NPI | 1588602148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 44319) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME118291) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-08-09 |