| NPI | 1851740609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 55629) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2016015671) |
| Enumeration Date | 2016-06-11 |
| Last Update Date | 2023-03-29 |