| NPI | 1952763484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017540) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4143) |
| 207P00000X Emergency Medicine (Licence: KY 04369) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-01-13 |