| NPI | 1962762187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY TP496) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.138256) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2024-06-11 |