| NPI | 1760524391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 49613) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 39773) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2013-03-11 |