| NPI | 1891176426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 51575) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 29773) |
| 207P00000X Emergency Medicine (Licence: KY R3865) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-04-06 |