| NPI | 1790740611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 31271) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 31271) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-12-08 |