| NPI | 1811972383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 26527) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 26527) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2015-03-06 |