| NPI | 1013969021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34-00-5987) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 1629) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-03-14 |