| NPI | 1770625972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY r1147) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 43510) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-07-14 |