| NPI | 1881002129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 69787) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R3458) |
| 207P00000X Emergency Medicine (Licence: KY TP978) | |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2018-08-15 |