| NPI | 1851321244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY TP306) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME95742) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2013-08-01 |