| NPI | 1649451881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0437239) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2018027906) |
| 207P00000X Emergency Medicine (Licence: TN 47187) | |
| 207P00000X Emergency Medicine (Licence: GA 064302) | |
| 207P00000X Emergency Medicine (Licence: NC 141093) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2018-08-30 |