| NPI | 1912258070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 55900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 67010) |
| 207P00000X Emergency Medicine (Licence: NY 284238) | |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2023-05-04 |