| NPI | 1871931816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 55535) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 53104) |
| 207P00000X Emergency Medicine (Licence: NC 2016-00083) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2022-10-07 |