| NPI | 1598785149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 01057913A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.137428) |
| 208D00000X General Practice (Licence: KY 48777) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-08-30 |