| NPI | 1811340946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 52230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4051) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2023-04-12 |