| NPI | 1730116625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 37656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 37656) |
| 208000000X Pediatrics (Licence: KY 37656) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2019-10-30 |