| NPI | 1952310831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.08482R) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: LA 08482R) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-07-02 |