| NPI | 1740285311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 54452) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35084388) |
| 207P00000X Emergency Medicine (Licence: IN 01084730A) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2020-11-18 |