| NPI | 1780602037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 31201) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01044634A) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-05-28 |