| NPI | 1023110996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301096161) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.088278) |
| 207P00000X Emergency Medicine (Licence: NE 28091) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2017-01-23 |