| NPI | 1902031610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 48422) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R2240) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2012-06-24 |