| NPI | 1730128430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 34922) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 2001-42) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-06-06 |