| NPI | 1730322413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.099677) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP610) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2021-01-07 |