| NPI | 1871026492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 55545) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2018-02834) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2021-07-27 |