| NPI | 1811195167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 48129) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01064049A) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2020-12-11 |