| NPI | 1871598367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 39532) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY ky44320) |
| 207P00000X Emergency Medicine (Licence: OH 35084147) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2022-07-21 |