| NPI | 1043448608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34010559) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 243361) |
| 207P00000X Emergency Medicine (Licence: UT 79252871204) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2020-07-14 |