| NPI | 1982641635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 160395) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 02816) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2014-06-20 |