| NPI | 1992759294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101038103) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 21412) |
| 207P00000X Emergency Medicine (Licence: PA MD434415) | |
| 207P00000X Emergency Medicine (Licence: KY 43221) | |
| 207P00000X Emergency Medicine (Licence: OH 35-090652) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2014-05-19 |