| NPI | 1588689962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 19071) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-07-4460-S) |
| 207P00000X Emergency Medicine (Licence: KY 34064) | |
| 207P00000X Emergency Medicine (Licence: VA 0101239994) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-10-31 |