| NPI | 1891923900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 54384) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 268953-1) |
| 207P00000X Emergency Medicine (Licence: OH 123659) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2021-03-26 |