| NPI | 1003010539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 03339) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34008638) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2015-05-07 |